ST. JAMES - The flat coastal plain, punctuated by trailers and cornfields, offers few clues that this is the home of the Waccamaw-Siouan Indians, a little-known tribe that has lived in southeastern North Carolina since the mid-1700s.

But this small tribe has become the center of a movement that is quietly trying to change the future of an invisible, and often neglected, population.

On Sunday, more than two dozen aspiring doctors from around the world wrapped up five weeks of volunteer work among North Carolina's Indian tribes. They helped run day camps and leadership courses, planned wellness centers and worked in Indian hospice programs -- all efforts to address health problems that afflict Indians more than any other population.

American Indians in North Carolina, like those around the country, are more likely than any other group to get, and have serious complications from, diabetes, studies show. Compared with white people, they are at higher risk for high blood pressure, asthma, obesity and mental illness. They are less likely to visit doctors, have health insurance, exercise or eat balanced diets.

"American Indians live sicker and they die younger," said Anthony Fleg, a medical student at UNC-Chapel Hill who started the volunteer project. "It's unjust. But in the eyes of many folks, American Indians are not even on the radar."

While North Carolina may seem an unlikely place for what Fleg calls the Native Health Initiative, he points out that North Carolina is home to the largest Indian population east of the Mississippi, an estimated 108,000 people. And unlike those in the American West, most of the state's tribes are not federally recognized, meaning they receive few public resources.

The ancestral homes of many of North Carolina's eight state-recognized tribes sit in the state's most impoverished counties. And in some cases, Indians go unnoticed even by their neighbors.

When the project began in 2005, Fleg said, two volunteers went to Columbus County leaders to discuss involving Waccamaw-Siouan students in school sports. "They were told very politely, 'We don't have any Indian students here,' " Fleg said. "If they're not noticed, how are they going to be well served?"

Fleg's volunteers say the program, which operates without paid staff and little funding, is the only one in the country that engages medical students in Indian communities rather than simply cycling students through clinics. They say they see themselves not as saviors but as seekers who want to forge a connection that could change the troubled relationship between American Indians and conventional doctors.

The program expanded from about 10 volunteers each of the first two years to 26 this year. Because of the program's rising profile, UNC's medical school will soon offer a course in American Indian health. Some see it as the start of a new awareness of the struggles of American Indians.

"We've always been used in unethical ways for the outside world to get what they needed," said Missy Brayboy, a Lumbee Indian and the community services director at the N.C. Commission of Indian Affairs. "Here we have a group of young people that want to give to us."

Learning a culture

Inside the St. James Community Center, at a Columbus County crossroads about 125 miles south of Raleigh, the Waccamaw-Siouan tribe is very much alive.

A dozen brown-skinned girls are tangled in a heap on the tile floor, giggling and groaning as Colleen Keough tells them to put their right foot on green.

Keough, 21, recently graduated from the University of Texas and plans to enroll in medical school. This is her third week of helping supervise a group of rambunctious elementary and middle schoolers as they do tribal dances, learn about health and culture, prepare nutritious lunches and, sometimes, play Twister.

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